Organization
DEO PR RETAIL 1 LLC
Active
Parent organization
SHALEM CONSUMER BRANDS
Other names
deo
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHALEM CONSUMER BRANDS
Authorized official
MR. GUSTAVO ANDRES GAUTREN (DIR. OF. OPERATIONS)
(782) 429-6724
Entity
Organization
Contact information
Practice address
AVENIDA DE DIEGO, 310 PLAZA DE DIEGO LOCAL 102B, SAN JUAN, PR 00909
(787) 776-8570
Mailing address
162 MONTAGUE ST APT 2, BROOKLYN, NY 11201-3506
(646) 512-0313
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578111043
—
NY
Enumeration date
01/21/2020
Last updated
10/10/2023
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